| Objective:Drug resistance surveillance was performed onAIDS adult patients receivingantiviral therapy in Yunnan Province, so as to investigate the occurrence of drugresistance. To analysis the change trend of drug resistance in Yunnan Province bydetecting drug resistance genes combing with the analysis of epidemiological data,so as to provide scientific basis for the selection of antiviral therapy forAIDS adultpatients in Yunnan Province.Research methods:(1) The object of this research isAIDS adult patients who receiving highly activeanti-retroviral therapy during2008to2012in Yunnan Province.(2) Regular testing viral load with antiviral treatment in patients whose viral loadwere greater than1000copies/ml and the time of anti-viral therapy were longer thansix months, so as to analysis the prevalence of HIV-1in Yunnan Province.(3) To epidemiological and analysis data of the patients who test positive for drugresistance were filtered statistics, such as the beginning time of anti-retroviral therapy,district, gender, marital status, route of infection and other individual data.(4) To analysis the drug-resistant gene mutation.Result:(1) The detected people of drug-resistant genotypes of HIV in adult patients were3405in Yunnan from2008to2012.2512people were positive for HIV by PCR. Thepositive rate was73.77%(2512/3405), and drug resistance genes were tested in them. The test results indicated that occurrence of drug resistance has happened in1127people.By the end of2012, the total number of adults patients received antiviraltherapy were37430, then the resistant rate calculated with it as the base was3.01%(1127/37430).To comparing the five years in each of the drug-resistant rate for thetreatment of patients by chi-square test with line multiply by list data,arrive at the χ2＝325.25，P＜0.01，the difference was statistically significant.Considered for the eachyear have the same failure rate in drug therapy patient.Make further pairwisecomparisons,the differences were statistically significant, may be considered withresistance rates increased from2008to2012yearly in patients.(2) Drug resistance detection showed that patients were mainly resistant to nucleosidereverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor, andthe majority of patients were resistant to both two types of drugs. Patients withmultidrug resistance increased along with the prolong of anti-viral therapy. M184V/Iand K103N/S were the top two high-frequency resistant mutation sites, and theproportion they counted were57.5%and40.64%respectively. In nucleoside drugs,lamivudine (3TC) and emtricitabine (FTC) were with the highest resistance rates; thenumber were54.48%(614/1127) and54.13%(610/1127) respectively. Innon-nucleoside drugs, nevirapine (NVP) and efavirenz (EFV) were with the highlyresistance rates; the number were83.5%(941/1127) and56.52%(637/1127)respectively; drug resistance rates of protease was all very low.(3) The ratio of resistant patients was1.7:1(632/372) male to female from2008to2012, which was dominated by men, and the number of female patients increased yearby year. Prime-age person were the main resistant patients, which mainly in the age of26-55years. Patients with26-45years old were the main component, whichaccounted for71.8%(755/1051). In terms of marital status, patients married orcohabiting accounted for66.3%(697/1051). Intravenous drug and heterosexualtransmission were the main infections pathways, which accounting for more than85%.The infection ways of three resistant patients in2008were all by intravenous drug.From2009to2012, these cases had been increased every year, but the proportiongradually decreased. However, the number of resistant patients infected by heterosexual transmission increased year by year, which also occupied the largestproportion. The drug resistance was often be found in1year,2years and3years sincethey received antiviral therapy, among which there were the most resistant patients in1year. This indicated that1year was the most vulnerable time on which the resistanceoccurs inAIDS patients receiving anti-retroviral therapy. Resistant patients weremainly distributed in the Dehong Prefecture31.94%(360/1127), Kunming11.27%(127/1127), Red River State10.65%(120/1127) and Lincang23%(104/1127), amongwhich, annual resistant patients in Dehong Prefecture were always highest.Conclusion:(1) The total drug resistance rate ofAIDS adult patients in Yunnan province was3.01%, and drug-resistant strains were in low endemic situation. The number of drugresistant species has been increasing year by year since2008to2012in Yunnanprovince,and the drug resistance rate increased year by year.(2)They were mainly resistant to nucleoside reverse transcriptase inhibitor andnonnucleoside reverse transcriptase inhibitor,followed by nucleoside analogue reversetranscriptase inhibitors.And the occurrence of multidrug resistance increased year byyear.(3) Drug resistance varied different in different regions of Yunnan Province. Resistantpatients were mainly distributed in Dehong Prefecture, Honghe Prefecture, Kunming,Lincang and other places.Among which, there had the most resistant patients inDehong Prefecture.AIDS patients in Lijiang and Diqing Prefecture has not happeneddrug-resistant yet in this research. |
PDF Full Text Request